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      Association Between Receipt of Unemployment Insurance and Food Insecurity Among People Who Lost Employment During the COVID-19 Pandemic in the United States

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      , ScD 1 , , , ScD 2 , , MD, PhD 3 , 4
      JAMA Network Open
      American Medical Association

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          Key Points

          Question

          Was the receipt of unemployment insurance and a $600/wk federal supplement to unemployment insurance associated with reduced food insecurity among people in low- and middle-income households who lost work during the coronavirus disease 2019 (COVID-19) pandemic?

          Findings

          In this cohort study of 1119 adults who lost work during the COVID-19 pandemic, unemployment insurance was associated with a 35% relative decline in food insecurity and a 48% relative decline in eating less due to financial constraints. The $600/wk federal supplement was associated with additional reductions in food insecurity.

          Meaning

          These findings suggest that expanding the amount and duration of unemployment insurance may be an effective approach to reducing food insecurity.

          Abstract

          This cohort study evaluates the association between receipt of unemployment insurance, including a $600/wk federal supplement between April and July, and food insecurity among US residents who lost their jobs during the coronavirus disease 2019 (COVID-19) pandemic.

          Abstract

          Importance

          More than 50 million US residents have lost work during the coronavirus disease 2019 (COVID-19) pandemic, and food insecurity has increased.

          Objective

          To evaluate the association between receipt of unemployment insurance, including a $600/wk federal supplement between April and July, and food insecurity among people who lost their jobs during the COVID-19 pandemic.

          Design, Setting, and Participants

          This cohort study used difference-in-differences analysis of longitudinal data from a nationally representative sample of US adults residing in low- and middle-income households (ie, <$75 000 annual income) who lost work during the COVID-19 pandemic. Data were from 15 waves of the Understanding Coronavirus in America study (conducted April 1 to November 11, 2020).

          Exposure

          Receipt of unemployment insurance benefits.

          Main Outcomes and Measures

          Food insecurity and eating less due to financial constraints, assessed every 2 weeks by self-report.

          Results

          Of 2319 adults living in households earning less than $75 000 annually and employed in February 2020, 1119 (48.3%) experienced unemployment during the COVID-19 pandemic and made up our main sample (588 [53.6%] White individuals; mean [SD] age 45 [15] years; 732 [65.4%] women). Of those who lost employment, 415 (37.1%) reported food insecurity and 437 (39.1%) reported eating less due to financial constraints in 1 or more waves of the study. Among people who lost work, receipt of unemployment insurance was associated with a 4.3 (95% CI, 1.8-6.9) percentage point decrease in food insecurity (a 35.0% relative reduction) and a 5.7 (95% CI, 3.0-8.4) percentage point decrease in eating less due to financial constraints (a 47.8% relative reduction). Decreases in food insecurity were larger with the $600/wk supplement and for individuals who were receiving larger amounts of unemployment insurance.

          Conclusions and Relevance

          In this US national cohort study, receiving unemployment insurance was associated with large reductions in food insecurity among people who lost employment during the COVID-19 pandemic. The $600/wk federal supplement and larger amounts of unemployment insurance were associated with larger reductions in food insecurity.

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          Most cited references28

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          How Much Should We Trust Differences-In-Differences Estimates?

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            Food Insecurity And Health Outcomes.

            Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.
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              Food insecurity is associated with chronic disease among low-income NHANES participants.

              Food insecurity refers to the inability to afford enough food for an active, healthy life. Numerous studies have shown associations between food insecurity and adverse health outcomes among children. Studies of the health effects of food insecurity among adults are more limited and generally focus on the association between food insecurity and self-reported disease. We therefore examined the association between food insecurity and clinical evidence of diet-sensitive chronic disease, including hypertension, hyperlipidemia, and diabetes. Our population-based sample included 5094 poor adults aged 18-65 y participating in the NHANES (1999-2004 waves). We estimated the association between food insecurity (assessed by the Food Security Survey Module) and self-reported or laboratory/examination evidence of diet-sensitive chronic disease using Poisson regression. We adjusted the models to account for differences in age, gender, race, educational attainment, and income. Food insecurity was associated with self-reported hypertension [adjusted relative risk (ARR) 1.20; 95% CI, 1.04-1.38] and hyperlipidemia (ARR 1.30; 95% CI, 1.09-1.55), but not diabetes (ARR 1.19; 95% CI, 0.89-1.58). Food insecurity was associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% CI, 1.04-1.41) and diabetes (ARR 1.48; 95% CI, 0.94-2.32). The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity (ARR 2.42; 95% CI, 1.44-4.08). These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                29 January 2021
                January 2021
                29 January 2021
                : 4
                : 1
                : e2035884
                Affiliations
                [1 ]Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
                [2 ]Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
                [3 ]Leonard Davidson Institute for Health Economics, University of Pennsylvania, Philadelphia
                [4 ]Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
                Author notes
                Article Information
                Accepted for Publication: December 11, 2020.
                Published: January 29, 2021. doi:10.1001/jamanetworkopen.2020.35884
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Raifman J et al. JAMA Network Open.
                Corresponding Author: Julia Raifman, ScD, Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02446 ( jraifman@ 123456bu.edu ).
                Author Contributions: Dr Raifman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Raifman, Venkataramani.
                Acquisition, analysis, or interpretation of data: All authors.
                Drafting of the manuscript: Raifman.
                Critical revision of the manuscript for important intellectual content: All authors.
                Statistical analysis: Raifman, Venkataramani.
                Obtained funding: Raifman.
                Administrative, technical, or material support: Raifman.
                Conflict of Interest Disclosures: Dr Raifman reported receiving grants from the Center for Antiracist Research during the conduct of the study. Dr Venkataramani reported receiving grants from the Robert Wood Johnson Foundation, the National Institutes of Health, and the University of Wisconsin Center for Financial Studies and US Social Security Administration during the conduct of the study. No other disclosures were reported.
                Funding/Support: This study was supported by the Boston University Clinical and Translational Science Institute grant UL1TR001430 from the National Institutes of Health and the Robert Wood Johnson Evidence for Action Program Grant 77922. The project described in this article relies on data from survey(s) administered by the Understanding America Study, which is maintained by the Center for Economic and Social Research at the University of Southern California. The collection of the Understanding America Study coronavirus disease 2019 tracking data is supported in part by the Bill and Melinda Gates Foundation and by grant U01AG054580 from the National Institute on Aging.
                Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the University of Southern California or the Understanding America Study. Dr Raifman affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
                Additional Information: Data are publicly available from the Understanding Coronavirus in America Study. Data analysis files are available from the corresponding author.
                Article
                zoi201075
                10.1001/jamanetworkopen.2020.35884
                7846943
                33512519
                e58b2b84-7331-4862-bbeb-6be74d704893
                Copyright 2021 Raifman J et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 20 August 2020
                : 11 December 2020
                Categories
                Research
                Original Investigation
                Online Only
                Public Health

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